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Stroke assessment and management in pre-hospital settings

02 August 2017
Volume 9 · Issue 8

Abstract

This article will review the assessment and management of acute stroke in the pre-hospital setting. Stroke affects over 111,000 individuals per year, with almost 1 million individuals living with the after effects of stroke in England today. 85% of all strokes are ischaemic, treatments including with intravenous thrombolytic agents and mechanical thrombectomy, the remaining 15% haemorrhagic strokes are able to managed with decompressive hemicraniectomy. The key risks factors for stroke will also be briefly discussed, since they are commonly presenting conditions in the pre-hospital setting. A range of specific stroke assessment tools will be presented – not all are used, nor appropriate, for the pre-hospital setting – but it is useful to be aware of these. The article will also include differential diagnosis and stroke mimics. The key features of acute stroke are the sudden onset of focal neurological sings and symptoms.

Stroke is a medical emergency and a significant clinical event. In England and Wales almost 90,000 individuals are hospitalised annually with an acute stroke, 85% of which are ischaemic in nature, 10% due to primary haemorrhage and 5% due to subarachnoid haemorrhage.

Stroke deaths account for 11% of all deaths (RCP, 2016) and whilst the majority of individuals survive their first stroke; the risk of suffering a second stroke within 5 years is 26% and 39% by 10 years (Mohan & Wolfe et al, 2011).

Due to improvements in care, the majority of patients survive their first stroke, although with significant resulting morbidity. Currently in England, 900,000 people are living with the effects of stroke, with 50% dependent on other people for help with everyday activities and stroke remains the largest cause of disability in the UK (Mackay & Mensah, 2004). Stroke has a large burden in the health economy, estimated to cost the NHS around £3bn per year, with additional cost to the economy of a further £4bn in lost productivity, disability and informal care (NHSE, 2017)

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